Transitions Coordinator – Post Acute

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Oversee and manage member transitions in level-of-care to and from long-term care, respite nursing facility services, and HCBS waiver services.

• Handle the enrollment and disenrollment processes for home and community-based waiver services through clinical review and benefits management.

• Collaborate with care coordination, waiver service coordination staff, and other stakeholders as part of the interdisciplinary care team.

• Conduct nursing-facility level-of-care assessments, respite request evaluations, and waiver enrollment/disenrollment tasks.

• Confirm member eligibility, enrollment history, and demographic information.

• Monitor and support members in maintaining their benefit eligibility during transitions.

• Coordinate and record clinical reviews and requested services within the clinical documentation system.

• Assist with appeals processes and gather necessary clinical documentation.

• Facilitate discharge planning and ensure safe transitions between different levels of care.

• Review medical records, contacts, treatment plans, case notes, referrals, and assessments for compliance and accreditation.

• Aid in the development and implementation of care plans.

• Attend interdisciplinary team meetings, State Hearings, and Medical Advisement meetings as requested.

• Raise care coordination needs and refer quality issues to Quality Improvement.

• Stay informed about federal and state regulations, CareSource contracts, provider agreements, and Medicare/Medicaid benefits.

• Mentor and precept new staff members.

• Engage in special projects or research initiatives.

• Maintain required reporting and assist with data analysis.

⛳️ Requirements

• Completion of an accredited Registered Nurse (RN) degree program or a degree necessary to qualify for Social Worker licensure in Ohio.

• Current, unrestricted licensure as a Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) in Ohio.

• A minimum of three (3) years of experience in case management and/or managed care.

• Intermediate proficiency in Microsoft Office Suite.

• Basic understanding of a Windows-based environment.

• Capability to operate a smartphone, iPad, or other mobile communication devices.

• Exceptional written and verbal communication abilities.

• Capacity to work with diverse populations in a non-judgmental manner.

• Ability to work autonomously as well as collaboratively within a team.

• Strong organizational skills.

• Excellent assessment capabilities.

• Attention to detail.

• Familiarity with Medicare and Medicaid.

• Strong critical thinking and listening skills.

• Effective time management skills.

• Customer service-oriented approach.

• Decision-making and problem-solving abilities.

• Knowledge of evidence-based medical criteria and/or standards of care.

🏝️ Benefits

• Potential for bonuses linked to both company and individual performance.

• Comprehensive and substantial total rewards package.

• Attendance at in-person meetings may be required.

• Travel is generally not necessary.